4Change: Implications at the Water-Human Health Interface

The United Nations designated 2003 as the year of fresh water, which reaches across many academic and institutional fields and across political borders. Water has a broad influence on human health and ecosystem health and it is clear that its importance in the policy and health arena will continue to grow in the coming decades. Water challenges are complex, requiring the adoption of alternative paradigms across the globe for water policy, planning, and management.

Central to the rising demands on water is the increase in population growth. The per capita availability of water across the planet is going down, because the population is increasing while the total amount of water on the planet is static. In some regions, the complementary rise in population and reduction in water availability are occurring rapidly. This problem is compounded by taxing an already vulnerable system in areas where the natural endowment is naturally low. The increasing demands with population growth are more problematic when one considers that the per capita demand for water—the amount we use per person for the things we want to do—is rising in many regions, driven by economic growth.

The per capita availability of water across the planet is going down, because the population is increasing while the total amount of water is static.

Peter Gleick

Population growth adds other pressures to a tightly intertwined ecosystem. As the population grows, additional demands on natural resources and shifting of land-use patterns occur to meet the basic needs of

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This chapter is an edited transcript of Dr. Peter Gleick’s remarks at the workshop.

populations. Currently, the amount of irrigated land worldwide is still growing, but because the population is growing even faster, per capita irrigated land area is decreasing. This has enormous implications for food production, because it places increasing pressure on available resources—particularly fertilizers and pesticides—to get greater yield out of every hectare in production.

Furthermore, we are seeing a swift and irreversible ecological change in aquatic ecosystems. Many fish species are threatened or endangered, and some aquatic ecosystems have been altered or destroyed completely. The issue of climate change is perhaps the quintessential global change issue, with enormous—and not completely understood—implications for water. It is clear, however, that as competition for fresh water grows, not only between regions but between different sectors within regions, political tensions and conflicts inevitably occur.

Approximately 1.1 billion of the world’s people do not have access to clean drinking water and 2.4 billion people—40 percent of the global population—lack adequate sanitation services.

Peter Gleick

All of the changes in the ecosystem are important, but the fact remains that we are already having problems meeting the water demands of our population. Approximately 1.1 billion people do not have access to clean drinking water and 2.4 billion people—40 percent of the global population—lack adequate sanitation services. These failures to meet basic human needs for water lead to hundreds of millions of cases of water-related diseases—cholera, dysentery, schistosomiasis, guinea worm—every year. The United States and Western Europe eliminated these diseases long ago, but they remain major problems in many parts of the world.

In the United States and Western Europe, our water quality challenges have shifted toward persistent chemicals, hormones, pharmaceuticals, and trace elements. Unsustainable groundwater overdraft is occurring in many parts of the world: groundwater is being pumped faster than it is naturally being recharged. This is a problem in California, India, and many other places around the world. In some cases, this is accelerating the deterioration of

Unsustainable groundwater overdraft is occurring in many parts of the world: groundwater is being pumped faster than it is naturally being recharged.

groundwater quality; as we pump the water faster and faster, contaminants may spread more rapidly through aquifers.

Many observers describe these water problems as a crisis, not localized in particular regions but on a global scale. The unmet basic needs for water—those 1.1 billion people without clean drinking water and 2.4 billion people with inadequate sanitation services—continue to take their toll. This omission, arguably the greatest development failure of the twentieth century, now haunts the twenty-first century, notably in humanity’s burden of water-related diseases. The World Health Organization’s current estimate is that two million to five million deaths a year are caused by these diseases, virtually all of which are preventable.

This issue is not unknown. In fact, two of the Millennium Development Goals set in 2000 by the United Nations and the world development community explicitly address water. They aim to reduce by half the proportion of people without access to clean water and to reduce by half the proportion that lack sanitation services, by 2015. However, these aggressive goals, though well-intentioned, are not likely to be met. The level of commitment on the part of the principal actors—governments, intergovernmental organizations, international financial institutions, and nongovernmental organizations (NGOs)—is simply insufficient. For example, total overseas development assistance (ODA) in the water supply and sanitation sector—all aid from developed countries plus all aid from international financial institutions such as the International Monetary Fund and the World Bank—is decreasing.

One example is the United States, which gives the smallest amount of water aid as a fraction of its gross national product (GNP) of any of the developed countries. Its total water aid is about $400 million, which goes to 14 countries, mostly in the Middle East. All U.S. ODA to Africa in water supply and sanitation in 2001 amounted to only $5 million to $10 million. Yet it is not just money that is required. The United States has enormous educational resources, technological resources, and many other resources that could be contributing to the solution.

The twentieth century was a time in which water demand was met through increased water supply. Governments built dams, aqueducts, reservoirs, and pipelines, and water was taken from the environment without really understanding the ecological implications of these actions. Thus, there has been ecosystem collapse and con-

As we have failed to meet basic human needs for water, we similarly have failed to meet environmental needs for water.

tamination because dams modify river flows, temperatures, and water quality; trap sediments that prevent the recharge of deltas; and jeopardize the fisheries that depend on them. More than 20 percent of North American freshwater fauna are now considered threatened or endangered because adequate flows do not reach the deltas of many major rivers.

These are old, although unfortunately continuing, trends, particularly in the developing world, but there also are new concerns. Recently in India, for example, a small environmental group released a study of pesticides in Indian bottled beverages. The group bought the products from 10 different beverage companies and reported that each sample had pesticide levels above acceptable standards. In governmental tests, the results turned out to be the similar. The conclusion is clear: there are pesticides in the beverages from bottling companies in India.

In hindsight, it should be no surprise that there is a pesticide problem with Indian bottled beverages. It is a problem in the United States, why shouldn’t it be a problem elsewhere? There are pesticides in source waters across the planet. In developing countries, which now face these kinds of new problems in addition to old problems, the financial and institutional resources to adequately address either of them are lacking.

We must now add to all this the looming effects of climate change. Although there are many things we still don’t know for sure—the timing, location, and extent of regional climate effects, the cost of doing something about them; the cost of not doing something about them; the consequences of the Kyoto agreement; we are increasingly sure that some major climate changes will occur. Indeed, we are already seeing evidence of climate changes and it will clearly have important, and likely adverse, effects on the hydrologic cycle and on the systems that have been built to provide us with clean drinking water supplies and with sanitation services.

We need a new paradigm offering a fresh way of thinking about water management and policy. The problem is not just that we haven’t built enough water supply and sanitation systems in developing countries, although that is true in some places. I would argue, however, that we are often advocating and undertaking the wrong programs. The infrastructure we have established here in the United States and elsewhere in the developed world may not be a better way to address basic needs for water supply and sanitation in developing countries. For

We need a new paradigm—fresh ways of thinking about water management and policy.

example, we are not going to meet basic needs for drinking water and sanitation services solely with centralized infrastructure, with the kinds of wastewater treatment plants that our large engineering companies know how to build and sell and that our large financial institutions know how to fund. In certain urban areas these kinds of systems could be the most appropriate. However, we may need other systems in other locations, such as community-scaled and community-managed water supply systems.

Sometimes we need things such as point-of-use purification, rainwater harvesting, or non-water-based sanitation, options that may be low tech but can still be science-based, rigorous, and successful. Contrary to conventional wisdom, which holds that we cannot depend on the individual household to disinfect its water, sometimes small-scale decentralized options are more reliable.

Ultimately, a new paradigm will be adopted on a global scale only if it becomes established within the major funding institutions. The World Bank, for example, understands very well how to evaluate, support, and fund large infrastructure; it excels at large, concentrated efforts rather than numerous small initiatives. We have to be more creative about modifying established mechanisms, or creating new ones, to finance such programs.

In that spirit, I offer what I believe are the necessary priorities:

We have to meet the basic human needs of water for everyone. This is a fundamental human right. The Millennium Development Goals are an effort to push government policy in this direction, but they need more support.

Smart use of existing infrastructure is critical. We have a substantial network of infrastructure in existence, but it has to be operated in different ways, especially under conditions of climate change. Until recently, water managers were trained to assume that the future would look like the past. If we had 50 years of hydrologic records, for example, hydrologists would be able to produce the statistics that told us the probabilities of floods and droughts and we could then operate our reservoirs accordingly. Now, however, the climatologists are telling us that the future is not going to look like the past. We will have to plan differently and use available tools in new and imaginative ways.

In most places, efficient use of water should take precedence over new supply. This does not mean brown lawns and fewer showers or not flushing our toilet as often as we would like. It means meeting our

needs with less water. The fact is that water use under routine conditions tends to be enormously inefficient. Even in California, despite the programs that have already been put in place—some of which are quite innovative—a recent study by the Pacific Institute in Oakland found that the state could reduce urban water use 30 percent merely by deploying existing technology more effectively.

We need to rethink what we mean by supply. Water supply doesn’t just mean a new, large, centralized infrastructure. Supply also can mean thinking of reclaimed and recycled water as an asset instead of a liability. Reclaimed water is valuable for groundwater recharge, power plant cooling, municipal landscapes, and some kinds of irrigation, among other uses. By better matching the demand for water with the quality of water, supply takes on an entirely different meaning. All of a sudden, there is a lot more water out there.

We need to make wider and more reliable, commitments of resources. We are not meeting our stated funding commitments, but even if we did, they would still be too low. It is not just a question of money, however, but of technology, training, and institutional capacity-building. There are many additional programs we can adopt that transcend the purely monetary.

When we do spend money, we have to vary what we fund and where we fund it.

We need to support different programs and explore opportunities in different areas and, in some cases, work with different kinds of agencies such as NGOs and smaller-scale agencies to develop community-level water-management systems. There is a lot of expertise; it is just not in the areas that we traditionally fund.

Essentially, we have to shift to a new way of thinking about water, especially regarding its connections with human health. One way is to profit from the experiences of other countries, recognizing that ingenuity is universal and industrialized nations should not only assist developing nations as much as possible but also learn from them. South Africa, for example, has excelled at integrating ecological restoration and protection as a fundamental part of water policy. The nation’s constitution explicitly guarantees meeting the basic

Ingenuity is universal and industrialized nations should not only assist developing nations as much as possible but also learn from them.

water requirements of all residents and ecosystems through a water “reserve”—a science-based program that reflects high but realistic standards and detailed knowledge of local environmental conditions. Botswana is another country that truly understands the value of its environmental flows, motivated by its economic reliance on ecological tourism.

Similarly, developed countries have much to teach us about smaller-scale community water systems, which have a long history but were largely pushed aside in the last century when the perception was that the developed world had all the answers. Many small-scale systems have proven to work at the community level—and to work at high efficiency—in the developing and developed worlds alike.

There are many connections between water policy and human health, and they are complex. This requires that our approaches to addressing them also be complex—our systems have to be multiple and varied. Despite the challenges, these goals are achievable and well worth the effort.

The Institute of Medicine's Roundtable on Environmental Health Sciences, Research, and Medicine was established in 1988 as a mechanism for bringing the various stakeholders together to discuss environmental health issues in a neutral setting. The members of the Roundtable on Environmental Health Sciences, Research, and Medicine come from academia, industry, and government. Their perspectives range widely and represent the diverse viewpoints of researchers, federal officials, and consumers. They meet, discuss environmental health issues that are of mutual interest, and bring others together to discuss these issues as well. For example, they regularly convene workshops to help facilitate discussion of a particular topic. The Rountable's fifth national workshop entitled From Source Water to Drinking Water: Ongoing and Emerging Challenges for Public Health continued the theme established by previous Roundtable workshops, looking at rebuilding the unity of health and the environment. This workshop summary captures the discussions and presentations by the speakers and participants, who identified the areas in which additional research was needed, the processes by which changes could occur, and the gaps in our knowledge.

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